New

Clinical Pharmacist 1

Spectraforce Technologies

$200.00

United States, Texas, Houston

Aug 04, 2026

Position Title: Clinical Pharmacist 1

Work Location: Remote

Assignment Duration: 3 Months

Work Schedule: 9am - 6pm EST No OT

Position Summary:

Pharmacy Appeals Department - Dept 247 Inclusive team culture, learning environment (not punitive) Pharmacy Ops Dept includes PA and Appeals - no key projects Evaluate redetermination and appeals coverage requests Department growth Increased volume
Typical Day in the Role
* Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness. * Verifies member's ID number and date of birth. * Verifies member's eligibility in the appropriate health plan eligibility system. * Records carrier and group number if applicable. * Checks for previous prior authorization decisions. * Verifies coverage in member's prescription benefit when necessary. * Verifies coverage in member's health plan benefit when necessary. * Evaluates prescription claim history. * Reviews chart notes and/or lab values. * Identifies provider specialty when appropriate. * Applies Medical Policy Criteria to prior authorization requests. * Evaluates whether request meets criteria for approval. * Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested. * Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool * Communicates with physicians regarding prior authorization: o For a non-formulary drug o Plan benefits, exclusions o Quantity limits o Age restrictions o Formulary alternatives * Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department) * Compiles data for reporting purposes: o Drug utilization of non-formulary drugs o Overturned IPS recommended denials o Audit pharmacy claims greater than $200.00 o Suggest addition or deletion of drugs to/from the formulary o Updating qty/days or age limit ends o Support National P&T Committee o Other tasks which may arise during the performance of any of the above mentioned duties

Qualification & Experience:

Candidate Requirements
Education/Certification	Required: Pharm D.	Preferred: n/a
Licensure	Required: Any US state	Preferred: n/a
Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: At least one year of professional RPh experience Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law Disqualifiers: n/a Performance indicators: * Sign 85 - 100 cases daily
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection	1	Self-Motivated/Good Time Management Skills
2	Working Knowledge of Office Suite
3	Goal Oriented